Clinical audit of the management and outcome of preterm prelabour rupture of membranes at Muhimbili National Hospital

Abstract

ABSTRACT Background: Preterm pre-labour rupture of membranes (PPROM) is among the leading causes of preterm birth which can lead to high perinatal morbidity and mortality along with maternal morbidity. Several guidelines on timely and appropriate management of PPROM are in place but are not always followed. Aim: The study aimed to conduct a clinical audit for the management and outcome of women with PPROM at Muhimbili National Hospital (MNH). Methodology: A clinical audit of women admitted with PPROM between January and December 2022 was conducted. Their records were reviewed to extract data on clinical management and these were abstracted into a structured checklist. The abstracted data was compared with the standard MNH PPROM management guidelines. Data was checked, entered, cleaned, and analyzed using SPPS version 23. Findings were presented using percentages to measure adherence and descriptive tables to show maternal and immediate fetal outcomes. Result: The mean gestational age at PPROM onset was 31.78±2.30 weeks. Most women with PPROM were correctly diagnosed through history (100%) and sterile speculum examination (95.8%) with 97.1% receiving corticosteroids and only 31.6% receiving the recommended prophylactic antibiotics. Caesarean delivery was achieved in 83.1% where 76% of the neonates were admitted to the neonatal intensive care unit, 89.6% had Apgar score of ≥ 7 at 5 minutes, and 91% had low birth weight. Chorioamnionitis and abruption placenta occurred in 8.4% and 4.2% of the women. Conclusion: Seven in ten women with PPROM received standard treatment. Antibiotic use was common but not guided by standard guidelines or lab investigations. Evidence-based interventions were not routinely performed, potentially impacting outcomes. The existing guideline needs to be reviewed to improve the management and outcome of women with PPROM.